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Ready to See a Fresh Approach to
Your Company's Health Insurance?

Rep Quotes & Proposal Requests

Submitting Rep *

Reps Email for Proposal Delivery *

Company Name *

State HQ *

Number of Employees / Staff

Coverage Effective Date Goal *

Current Benefits Offered *

No Benefits Offered
Health
Dental
Vision
Life
Disability Short/Long Term
Supplemental Health Plans
Retirement Plan / 401k
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Benefits They Would Like to Discuss *

Health
Dental
Vision
Life
Disability Short and/or Long Term
Supplemental Health
Retirement Plans / 401K
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Employer Contribution Details *

Retirement Offering Status *

Have Retirement Benefit But Want to Visit Still
Have Retirement Benefits and Satisfied
Nothing Currently and Want to Visit
Nothing Currently and DO NOT Want to Visit
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Need a Full Proposal Built? *

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Agent Notes *

Company Census Upload *

Name | DOB | ZIP | Dependents If Available | Job Titles | Hire Date | Salary for LTD + Employer Paid Life

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Get In Touch

Zach's Cell 763-458-6457

Minneapolis, MN, USA